Endoscopic Lung Volume Reduction Results in Improvement of Diaphragm Mobility as Measured by Sonography

Background: Hyperinflation in patients with pulmonary emphysema is an important cause of reduced diaphragm mobility. We investigated whether endoscopic lung volume reduction (ELVR) could improve diaphragm mobility. Methods: Diaphragm mobility data obtained by sonography from 44 patients were compared before and 3-6 months after ELVR therapy with a Spiration[TM] valve system. These patients were asked whether they wanted this procedure again after they had learned of their treatment outcome; this was a subjective indicator of outcome. Lung function parameters and blood gases were also measured. Results: After ELVR, 30 patients (82%) developed atelectasis of >50% of the targeted lung lobe. These patients had a diaphragm mobility increase of 28.97 [+ or -] 15.93 mm, while the remaining patients experienced an improvement in diaphragm mobility of 16.07 [+ or -] 21.17 mm; this difference was significant (p = 0.030). All 30 patients with atelectasis and additional 6 patients without radiologically demonstrated atelectasis perceived an improved outcome after ELVR. Their diaphragm mobility increased by 28.89 [+ or -] 17.26 mm. Conversely, the patients with no perceived improvement in outcome had a diaphragm mobility increase of 6.75 [+ or -] 12.76 mm; this difference was significant (p = 0.001). Conclusion: ELVR can improve diaphragm mobility, and this improvement is correlated with a perceived positive outcome in patients. Keywords: COPD, emphysema, diaphragm mobility, endoscopic lung volume reduction, ultrasound, outcome